Getting Real About Caring

3/8/2019 As a nurse leader, I failed to lead caring in health care. I’ve cared for patients, I’ve studied caring theories and science, and for nearly thirty years, I told myself that I was leading caring. Thinking about caring as a nurse leader has been a constant, prompting me to write about it at different stages in my career. I felt I was selling my soul to the health care industry. I tried to warn other nurses. As a new nurse, I submitted a manuscript to the American Journal of Nursing, urging nurses to remain true to themselves and to resist being swallowed up by medicine and health care. I knew even then that I was in trouble. And here I am many years later, unraveling the results. What I know is that nursing is ever evolving. Nursing’s history has paralleled the evolution of the human experience and society’s health, healing and caring needs within the consciousness of the time. Currently, society’s health, healing, and caring needs reflect wellness consciousness—where authenticity and human connectedness create well-being. Patients are not only seeking medical care in their health care encounters; they are also yearning for authentic connections. And it is nurses to whom they are turning for that connection. We are seeing this play out in patient experience metrics. And yet, nursing leaders, distracted by science, technology, and budgets, are not seeing the alignment between the public’s expanding caring expectations and nurses’ authentic caring. Jean Watson once wrote of nursing, “The change will come when nursing and nurses are directly aligned with the people they serve”. That alignment is before us, but not enough nursing leaders are rising to it. Beyond being distracted, there is another reason so many nurse leaders are not rising to the growing demand for authentic caring connection. They don’t know how. How do nurse leaders engage in this alignment in the health care industry? The generation of authentic caring is nurse-centric. Authentic caring originates within the nurse, sparks from a connection between the nurse and patient, is cultivated through a nurse’s internal resources, and can only be sustained by the nurse. How this exchange happens is personal. We know that stress undermines access to and cultivation of nurses’ authenticity. We know that how nurses relate to themselves impacts their authenticity and how they care. We know that nurse engagement requires organizational resources to mitigate the job stressors and nurses’ inner resources to navigate personal stressors. And we know that cultivation of nurses’ inner resources comes through self-care and reflection. Here is the problem: self-care cannot be mandated or managed by nurse leaders or organizations. This makes it complicated for nurse leaders and organizations to take it on; and yet, we must. Nurses’ self-care and caring consciousness not only impact nurses’ caring; it also drives their ability to thrive in nursing. Retention is our 21st-century challenge. If attrition trends are not reversed, none of the other worthy priorities nurse leaders are consumed in will matter. Up to 50 percent of new nurses are considering a way out of nursing. But we can ebb this tide. Nurses are motivated by their intrinsic desires to help others and rarely by organizations’ missions. Nurses find science and technology interesting and challenging, but it’s the human connections and caring that bring the sense of purpose and meaning to nurses. The health care industry is a beast to work in and is driving nurse attrition. Caring science is there to usher in better ways that help nurses thrive in nursing. Caring science research has defined caring relationships and has shown that authentic caring has a reciprocal nature. It is life-giving and life-receiving for both the patient and the nurse. I believe that nurse leaders are nurses’ only hope for expanded authentic caring in the health care industry given their common ground. Yet the scary reality is that they are in greater jeopardy than clinical nurses. It’s reported that more than 50 percent of nurse leaders were devising their exit plans. The nurse leader role is one of the most complex leadership roles across all industries. Nurse leaders are wedged between two major forces—medicine and business—making it difficult to preserve one’s sense of nursing identity and integrity. This is the reality for the 410,000 nurse leaders whose nurse followers are 3.1 million strong in the United States. The nurse leader job is full of high-risk, competing demands, fear of failing, and successes that are never enough. This was my experience as a nurse leader. Like the boiling frog parable, I didn’t jump out of the boiling water. Despite having studied caring theory and science at the University of Colorado under Jean Watson in my nursing doctorate education, I did not see caring science as a realistic option as a leader for too long. But then I did. It was my personal journey into wellness consciousness that saved me—fueled by self-care. I learned that how I live and work, what I focus on, and what I talk about impacts me and those around me. Up until then, I had allowed my leader self to dominate my authentic, caring self. I had to grapple with self-awareness, self-protection, and more before I could find my full authentic voice and lead caring. Until then, I remained stuck within the health care industry, the medicalization of care, and the business demands. How nurse leaders find their authentic leader selves takes many paths, yet there are few stories told. Unraveling where I went wrong and right in my career has catapulted me into telling my story. Nursing is a complex profession based on our social covenant with society. Nursing leadership’s unique challenge is to embolden this covenant. Nursing is the science of designing and providing caregiving individually and collectively. Medicine is the science and business of saving and improving lives. Health care is the business of providing medical services in caring organizations. Nurses juggle it all—saving lives, improving lives, and providing care within health care organizations. Nurses’ intrinsic, authentic caring attends to patients’ deep human needs, especially in vulnerable life moments. This is not what the health care industry supports and not what nursing leadership resembles. We are not leading authentic caring. We are not role modeling how to thrive in nursing. This is a time for nurse leaders to rise up and lead caring for the well-being of patients, nurses, and society.